Insurance expertise in Australia: adjusters, assessors and expert witnesses

Two sides of the same claim

Australian insurers usually appoint a loss adjuster for larger property and commercial claims. The adjuster investigates how the loss happened, checks it against the policy and recommends a settlement figure. Adjusting firms are independent businesses, but on a given claim their client is the insurer.

On the policyholder's side, the equivalent professional is commonly called a loss assessor, public loss assessor or claims advocate. They prepare the claim, gather technical and financial evidence, and negotiate with the insurer and its adjuster on your behalf. In business interruption matters, a forensic accountant often plays a central role, either alongside an assessor or engaged directly.

Licensing after the Royal Commission reforms

Following the reforms that came out of the Banking, Superannuation and Financial Services Royal Commission, handling and settling insurance claims became a regulated financial service from 2021. In broad terms, businesses that handle or settle claims, including many that act for policyholders, are expected to hold an Australian financial services licence or act under one. Before signing with any firm, search the ASIC professional and licensee registers and ask which licence they operate under.

Insurers are supervised by APRA for prudential matters and by ASIC for conduct. Most retail insurers also subscribe to the General Insurance Code of Practice, which sets service standards for claims handling, communication and timeframes.

Australian perils that shape the market

The country's climate explains why claims expertise is so developed. Large catastrophe events generate thousands of claims at once, stretch the capacity of builders and adjusters, and push repair costs up for months.

• Bushfire, especially in the south-east and Western Australia
• Riverine and flash flooding, as in the 2022 events in New South Wales and Queensland
• Tropical cyclones across northern Queensland, the Northern Territory and northern Western Australia
• Severe hail and east coast lows affecting major cities
• Subsidence, storm water ingress and long-tail building defects
• Business interruption following physical damage or loss of access

Points where disagreements usually start

Disputes rarely concern whether an event happened. They concern what caused the damage, how much it costs to fix and what the policy actually promises. Typical friction points include flood versus storm water distinctions, pre-existing wear and tear, the adequacy of a scope of works prepared by the insurer's builder, cash settlement offers that do not reflect real rebuilding costs, underinsurance, and the measurement of lost gross profit in business claims.

A policyholder's expert adds most value when they can challenge these points with independent evidence: a builder's quote, an engineer's report, a hydrologist's opinion or a forensic accountant's reconstruction of trading results.

Expert witnesses before courts and tribunals

If a claim ends up in litigation, expert witnesses give opinion evidence on technical issues. Australian courts require experts to comply with a code of conduct, under which their paramount duty is to the court rather than to the party who engaged them. Concurrent evidence, sometimes called hot-tubbing, where experts from both sides give evidence together, is also used in some courts.

Because of that duty of independence, the assessor who negotiated your claim is not always the best choice as an expert witness. Lawyers frequently retain a separate expert once proceedings are contemplated.

Complaints and external dispute resolution

The first step is the insurer's internal dispute resolution process. Ask for a written decision, the reasons, and copies of the reports the insurer relied on. Insurers must respond within set timeframes, and for most complaints that is generally around 30 calendar days.

If you are not satisfied, you can lodge a complaint with the Australian Financial Complaints Authority (AFCA). AFCA is free for consumers and eligible small businesses, can consider expert reports from both sides and can make determinations binding on the insurer if you accept them. Monetary limits and eligibility rules apply, so check them for larger commercial claims.

Deciding whether to bring in your own specialist

A simple contents or minor storm claim can often be managed directly with the insurer. Independent help becomes more relevant for total losses, complex building repairs, flood and cyclone claims where cause is contested, and any business interruption claim of significant size.

Compare at least two firms, read the engagement terms carefully and make sure you understand how they are paid. Our separate fee guides explain the usual structures in Australian dollars.

Early steps that protect your position

Whatever expert you eventually rely on, the first days matter. Make the property safe, photograph everything before clean-up, keep samples of damaged materials where you can, and list contents with any proof of purchase. Keep a log of every conversation with the insurer, its adjuster and builders.

Ask for copies of the reports the insurer relies on, and do not accept a cash settlement or sign a release until you are confident it reflects the full cost of repairs, including professional fees and any building code upgrades the policy covers.

• Building damage claims in Australia: working with your own loss assessor
• Business interruption claims in Australia: what your own expert will cost
• Fire and bushfire claims in Australia: the role of an independent assessor
• Fire and bushfire claims in Australia: understanding loss assessor fees
• Flood claims in Australia: when and how an independent assessor helps
• Independent help with a business interruption claim in Australia
• Paying an independent expert for a flood claim in Australia
• Storm, hail and cyclone claims in Australia: how assessor fees work
• Storm, hail and cyclone damage in Australia: working with an independent expert
• What an independent assessor costs for a building damage claim in Australia

Understanding who each expert works for is the first step towards a fair outcome. Use the Australian peril and fee guides on expertdassure.com to go further on your specific claim.